Impact of inpatient cardiac rehabilitation on Barthel Index score and prognosis in patients with acute decompensated heart failure
Impact of inpatient cardiac rehabilitation on Barthel Index score and prognosis in patients with acute decompensated heart failure
复制标题
DOI：
10.1016/j.ijcard.2019.06.071
复制
发表时间：
2019-10-15
影响因子：
3.5
通讯作者：
Kuwahara, Koichiro
中科院分区：
文献类型：
--
作者：
Motoki, Hirohiko;Nishimura, Musashi;Kuwahara, Koichiro
背景：虽然心脏康复(CR)可以改善慢性心力衰竭(HF)患者的运动能力和生活质量，但住院CR对急性失代偿性心衰(ADHF)患者的长期预后影响尚不清楚。我们研究了住院CR对ADHF患者残疾和预后的影响。方法：对171例ADHF患者进行CR，包括阻力训练和有氧运动。患者康复前(BIpre)和康复后(BIpost)的Barthel指数(BI)评分用于评估患者的残疾程度。结果：在研究队列中(中位年龄：76岁)，46名患者在平均478天的随访期内经历了全因死亡。BIpost受损(即BI<；60)与年龄增大、白蛋白、血红蛋白、估计肾小球滤过率(EGFR)和B型利钠肽(BNP)显著相关。在Kaplan-Meier分析中，BIpre和BIpost受损与全因死亡率显著相关。在基线BI受损的患者中，观察到改善的BI(Delta BI>；15)的结果更好。在调整了年龄、性别、EGFR、BNP、血红蛋白、白蛋白和左心室射血分数后，BIpost是全因死亡率的独立预测因子。结论：住院CR导致ADHF患者残疾的改善。基线残疾与预后不良有关。在基线BI受损的患者中，BI对住院患者CR的更大改善与更好的结果显著相关。ADHF患者应选择CR治疗。(C)2019爱思唯尔B.V.保留所有权利。
Background: Although cardiac rehabilitation (CR) can improve exercise capacity and quality of life in patients with chronic heart failure (HF), the long-term prognostic influence of inpatient CR on patients with acute decompensated HF (ADHF) is not well established. We examined the impact of inpatient CR on disability and prognosis in patients with ADHF.Methods: A total of 171 patients admitted for ADHF underwent CR that included resistance training and aerobic exercise. Patient disability was evaluated using Barthel Index (BI) scores at pre-(BIpre) and post-(BIpost) rehabilitation. All-cause mortality was retrospectively recorded after discharge.Results: In the study cohort (median age: 76 years), 46 patients experienced all-cause mortality during a median of 478 days of follow-up. Impaired BIpost (i.e., BI < 60) was significantly correlated with older age and lower albumin, hemoglobin, estimated glomerular filtration rate (eGFR), and B-type natriuretic peptide (BNP). In Kaplan-Meier analysis, impaired BIpre and BIpost were significantly associated with all-cause mortality. Better outcomes were observed for improved BI (Delta BI > 15) among patients with impaired baseline BI. BIpost was an independent predictor of all-cause mortality after adjusting for age, sex, eGFR, BNP, hemoglobin, albumin, and left ventricular ejection fraction.Conclusions: Inpatient CR led to improvements in disabilities among patients with ADHF. Baseline disabilities were associated with a poor prognosis. Greater improvements in BI to inpatient CR were significantly related to better outcomes in patients with impaired baseline BI. CR should be indicated for patients with ADHF. (C) 2019 Elsevier B.V. All rights reserved.